Employee Info

  • Employee Name:

  • Employee Title:

  • Employee Work Location:

Corporate H&S

  • Do you know where to find the H&S Policy?

  • Do you know what the H&S Program is?

  • Do you know where the H&S Program is located?

  • Is safety important to you?

  • What do you do to ensure you and your co-workers are working safely?

  • Is safety important to your supervisor?

  • Are you aware of the Safety Commitment Document signed by the Executive and IBEW? What does this mean to you?

40-10-50

  • If you were unable to keep your mind on your task (high risk jobs) and feel you might make an error, would you feel comfortable speaking up?

  • If you are a manager/ supervisor/ lead/ foreman: what would your response be if an employee said he / she couldn't do his high-risk work today because he/she was not focused on the job?

JHSC and Safety Meetings

  • Do you know who your representatives are on the JHSC?

  • Do you review the monthly minutes?

  • Do you attend the monthly Safety (Loss Control) Meetings?

  • Do you find the Safety (Loss Control) Meetings beneficial? If no, what could make it better?

PPE

  • Have you been trained on the proper use of PPE?

  • Do you know how to do a proper inspection of your PPE?

  • Would you be comfortable to speak up if your co-worker wasn't wearing the proper PPE?

Fire safety

  • Can you tell me how to use a fire extinguisher?

  • Are you aware of the emergency evacuation procedure?

Emergency response

  • Do you know how, and to whom you would report an emergency?

  • Could you tell me what you would do if anyone was injured?

  • Tell me if you or anyone you work with has experienced an injury?

  • Do you understand the incident reporting process?

WHMIS

  • Do you know where the MSDS location is?

Tailboard Conference

  • When do you complete a Tailboard Conference?

  • Do you receive feedback on the quality of the Tailboards?

Training

  • Do you have all the training you need to do your job?

  • Does your supervisor review your training compliance with you?

  • If you are a supervisor / manager, do you receive training reports for your department?

Employee & Family Assistance Program (In-Confidence Program)

  • Are you aware of the New EFAP and where to find the information?

Additional Comments:

  • In your opinion .... What is going well? What should be improved?

  • .

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.